Author

Date of Award

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department

Physician Assistant Studies

Department Chair

John Cavenagh, MBA, PhD, PA-C

Abstract

Objective: The objective of this selective EBM review is to determine whether or not is photodynamic therapy with topical 5-aminolaevulinic acid effective for the treatment of adults with recalcitrant hand and foot warts.

Data Sources: Two randomized controlled trials (RCTs) and one prospective, single-arm, phase II study published on/after 1999 comparing treatment of recalcitrant hand and foot warts before and after use of photodynamic therapy with topical 5-ALA were obtained using PubMed.

Outcomes Measured: Incidence of disappearance of recalcitrant hand and foot warts was the primary outcome measured, measured by Wilcoxon rank-sum test, Chi2 test, 2 way ANOVA, measured by a ruler, Fischer’s exact test for two group comparison, and Cox proportional- Hazards.

Results: Pain, skin pigmentation change, and phototoxic reactions were reported adverse events or side effects in some of the studies. Stender, Lock-Anderson and co-authors showed a statistically significant reduction in the frequency of warts, with a NNT of 2. Stender, Na and coauthors also showed a statistically significant reduction, with a NNT of 8. In a prospective study by Wang and co-authors 42% of patients showed complete remission of their recalcitrant hand and foot warts.

Conclusion: There was a significant reduction in the number of recalcitrant hand and foots warts achieved versus previously proposed methods for treatment. There was a statistically significant reduction in the recalcitrant hand and foot warts in all 3 studies, with almost half of the patients showing complete remission in Wang and co-authors study and low NNT of 2 and 8 by Stender, Lock-Anderson and co-authors and Stender, Na and co-authors respectively. To start making this more of a used modality for treatment, future larger studies with more patients with recalcitrant hand and foot warts are needed to evaluate the efficiency of photodynamic therapy with topical 5-ALA.